How Can I Come Back From An Achilles Rupture?

Dear Running Profs,

I’m looking to you all for advice. For the last 2 years I’ve been trying to make a comeback to running after rupturing my Achilles. I was running around 3:45 for a marathon before injury struck. Since then I’ve struggled to get back – only managing to run 6-7 miles tops. While I’ve been road biking to keep fit I do so long to start running again.

Aurel Phillips, via email

Aurel, it’s great to hear that you’re running again! a ruptured Achilles can mean a long rehabilitation program. As I’m sure you’re well aware, a complete rupture means 6 to 9 months off while if you’ve had surgery it’s going to have been a long 12 months of rehab.

When you say that you’ve only been managing 6-7 miles at a time, I’d take a guess that this is because the pain is too much after this point. While I’m not aware of the specific details of your rehabilitation, it is vital that you support your running with the rehab exercises. The theory is that you want to gradually load the Achilles’ tendon.

These exercises generally involve standing on tip toes or slowly lowering down from tip toe to the floor (make sure you see a physio to get a professional assessment of the exercise that you will need) but in my experience, the most common mistake with this group of exercises is not using enough weight.

In order to help your Achilles and calf complete return to being able to deal with the load demands of running (together they play a huge role in generating propulsion), it’s imperative that enough weight is used during exercises to cause total fatigue. It’s only by taking them to failure that the body will be stimulated enough to cause an adaptive response, i.e get stronger. Too many runners strive for 2-minute isometric contractions or 3o repetitions when in reality they would achieve more by adding enough weight to make 30 seconds or 12 reps challenging. If you take it to failure, you will see that in time it takes more and more weight to stop you, so access to a selection of weights at home or membership if a gym can make a big difference when it comes to your Achilles rehab.

Another point, though again this may not be the case for you, is not to fear pain. A serious injury like the total tear of a tendon can naturally leave you and more importantly you nervous system very wary of putting load through it again, especially when you start performing the same activity that you were doing when you tore it.

Pain is part of our incredibly sophisticated defense system, an alarm system that keeps us alive. It would be fairly useless system if it only went off after the damage had already been done, which is what pain is a warming of a threat and no a measure of the actual damage, In remembering this, try not to be afraid of 2’s and 3’s out of 10 (where 10 represents the worst pain you have ever felt). It often takes repeated exposure of 2’s and 3’s to help the system ‘desensitize’ and allow you to do more.

Both your rehab exercises and slowly more demanding running can be used to demonstrate to your defence system that it doesn’t need to be so protective. It may take time but it’s you that holds the reins.

Of course, ignoring 6’s and 7’s will have the opposite effect and create further threat to your system, which in return can cause an increase in sensitivity and see you start experiencing more pain after doing surprisingly less. Recovery is all about providing the right amount of exposure but not too much.

The road biking is a great idea to put a little more load through the tendon and improve your cardio fitness, but again make sure that you’re not shying away from a little pain.